sprains strains and other soft-tissue injuries

A twisting force to the lower leg or footis a common cause of ankle sprains.

Reproduced from The Body Almanac. American Academy of OrthopaedicSurgeons, 2003.

Sprains, Strains and Other Soft-Tissue InjuriesThe most common soft tissues injured are muscles, tendons, and ligaments. These injuries often occurduring sports and exercise activities, but sometimes simple everyday activities can cause an injury.

Sprains, strains, and contusions, as well as tendinitis and bursitis, are common soft-tissue injuries. Evenwith appropriate treatment, these injuries may require a prolonged amount of time to heal.

Cause

Soft-tissue injuries fall into two basic categories: acute injuries and overuse injuries.

Acute injuries are caused by a sudden trauma, such as a fall, twist, or blow to the body.Examples of an acute injury include sprains, strains, and contusions.

Overuse injuries occur gradually over time, when an athletic or other activity is repeated sooften, areas of the body do not have enough time to heal between occurrences. Tendinitis andbursitis are common soft-tissue overuse injuries.

Common Acute Soft-Tissue Injuries

Acute soft-tissue injuries vary in type and severity. When an acute injury occurs, initial treatment withthe RICE protocol is usually very effective. RICE stands for Rest, Ice, Compression, and Elevation.

Rest.Rest. Take a break from the activity that caused the injury. Your doctor may recommend thatyou use crutches to avoid putting weight on your leg.

Ice.Ice. Use cold packs for 20 minutes at a time, several times a day. Do not apply ice directly tothe skin.

Compression.Compression. To prevent additional swelling and blood loss, wear an elastic compressionbandage.

EleElevation.vation. To reduce swelling, elevate the injury higher than your heart while resting.

SprSprainsainsA sprain is a stretch and/or tear of a ligament, a strong band of connective tissue that connectthe end of one bone with another. Ligaments stabilize and support the body's joints. Forexample, ligaments in the knee connect the thighbone with the shinbone, enabling people towalk and run.

The areas of your body that are most vulnerable to sprains are your ankles, knees, and wrists. Asprained ankle can occur when your foot turns inward, placing extreme tension on the ligamentsof your outer ankle. A sprained knee can be the result of a sudden twist, and a wrist sprain canoccur when falling on an outstretched hand.

Sprains are classified by severity:

GrGrade 1 sprade 1 sprain (mild):ain (mild): Slight stretchingand some damage to the fibers (fibrils) ofthe ligament.

GrGrade 2 sprade 2 sprain (moderain (moderateate):): Partialtearing of the ligament. There isabnormal looseness (laxity) in the jointwhen it is moved in certain ways.

GrGrade 3 sprade 3 sprain (seain (sevvereere):): Complete tear ofthe ligament. This causes significantinstability and makes the jointnonfunctional.

While the intensity varies, pain, bruising, swelling,and inflammation are common to all three

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A severe hamstring injury where thetendon has been torn from the bone.

Tiny tears in the Achilles tendon causeit to swell and thicken.

categories of sprains. Treatment for mild sprains includes RICE and sometimes physical therapyexercises. Moderate sprains often require a period of bracing. The most severe sprains mayrequire surgery to repair torn ligaments.

StrStrainsainsA strain is an injury to a muscle and/or tendons. Tendons are fibrous cords of tissue that attachmuscles to the bone. Strains often occur in your foot, leg (typically the hamstring) or back.

Similar to sprains, a strain may be a simple stretch in your muscle or tendon, or it may be a partialor complete tear in the muscle-and-tendon combination. Typical symptoms of a strain includepain, muscle spasm, muscle weakness, swelling, inflammation, and cramping.

Soccer, football, hockey, boxing, wrestling andother contact sports put athletes at risk for strains,as do sports that feature quick starts, such ashurdling, long jump, and running races. Gymnastics,tennis, rowing, golf and other sports that requireextensive gripping, have a high incidence of handsprains. Elbow strains frequently occur in racquet,throwing, and contact sports.

The recommended treatment for a strain is thesame as for a sprain: rest, ice, compression andelevation. This should be followed by simpleexercises to relieve pain and restore mobility.Surgery may be required for a more serious tear.

Contusions (Bruises)Contusions (Bruises)A contusion is a bruise caused by a direct blow orrepeated blows, crushing underlying muscle fibersand connective tissue without breaking the skin. Acontusion can result from falling or jamming thebody against a hard surface. The discoloration ofthe skin is caused by blood pooling around theinjury.

Most contusions are mild and respond well with the RICE protocol. If symptoms persist, medicalcare should be sought to prevent permanent damage to the soft tissues.

Common Overuse Soft-Tissue Injuries

TTendinitisendinitisTendinitis is an inflammation or irritation of atendon or the covering of a tendon (called asheath). It is caused by a series of small stressesthat repeatedly aggravate the tendon. Symptomstypically include swelling and pain that worsenswith activity.

Professional baseball players, swimmers, tennisplayers, and golfers are susceptible to tendinitis intheir shoulder and arms. Soccer and basketballplayers, runners, and aerobic dancers are prone totendon inflammation in their legs and feet.

Tendinitis may be treated by rest to eliminatestress, anti-inflammatory medication, steroidinjections, splinting, and exercises to correctmuscle imbalance and improve flexibility.Persistent inflammation may cause significantdamage to the tendon, which may require surgery.

BursitisBursitisBursae, are small, jelly-like sacs that are locatedthroughout the body, including around the


Swelling associated with elbow bursitis.

shoulder, elbow, hip, knee, and heel. They contain a small amount of fluid, and are positionedbetween bones and soft tissues, acting as cushions to help reduce friction.

Bursitis is inflammation of a bursa. Repeated small stresses and overuse can cause the bursa inthe shoulder, elbow, hip, knee or ankle to swell. Many people experience bursitis in associationwith tendinitis.

Bursitis can usually be relieved by changes inactivity and possibly with anti-inflammatorymedication, such as ibuprofen. If swelling and paindo not respond to these measures, your doctor mayrecommend removing fluid from the bursa andinjecting a corticosteroid medication into thebursa. The steroid medication is an anti-inflammatory drug that is stronger than themedication that can be taken by mouth.Corticosteroid injections usually work well torelieve pain and swelling.

Although surgery is rarely necessary for bursitis, ifthe bursa becomes infected, an operation to drainthe fluid from the bursa may be necessary. Inaddition, if the bursa remains infected or thebursitis returns after all nonsurgical treatments have been tried, your doctor may recommendremoval of the bursa.

Removal (excision) of the bursa can be done using a standard incision (open procedure), or as anarthroscopic procedure with small incisions and surgical instruments. Your doctor will talk withyou about the best procedure for your medical needs.

Prevention

Injuries often occur when people suddenly increase the duration, intensity, or frequency of theiractivities. Many soft-tissue injuries can be prevented through proper conditioning, training, andequipment. Other prevention tips include:

Use proper equipment.Use proper equipment. Replace your athletic shoes as they wear out. Wear comfortable,loose-fitting clothes that let you move freely and are light enough to release body heat.

Balanced fitness.Balanced fitness. Develop a balanced fitness program that incorporates cardiovascularexercise, strength training, and flexibility. Add activities and new exercises cautiously.Whether you have been sedentary or are in good physical shape, do not try to take on toomany activities at one time. It is best to add no more than one or two new activities perworkout.

WWarm up.arm up. Warm up to prepare to exercise, even before stretching. Run in place for a fewminutes, breathe slowly and deeply, or gently rehearse the motions of the exercise to follow.Warming up increases your heart and blood flow rates and loosens up other muscles, tendons,ligaments, and joints.

Drink waterDrink water.. Drink enough water to prevent dehydration, heat exhaustion, and heat stroke.Drink 1 pint of water 15 minutes before you start exercising and another pint after you cooldown. Have a drink of water every 20 minutes or so while you exercise.

Cool down.Cool down. Make cooling down the final phase of your exercise routine. It should take twice aslong as your warm up. Slow your motions and lessen the intensity of your movements for atleast 10 minutes before you stop completely. This phase of a safe exercise program shouldconclude when your skin is dry and you have cooled down.

Stretch.Stretch. Begin stretches slowly and carefully until reaching a point of muscle tension. Holdeach stretch for 10 to 20 seconds, then slowly and carefully release it. Inhale before eachstretch and exhale as you release. Do each stretch only once. Never stretch to the point ofpain, always maintain control, and never bounce on a muscle that is fully stretched.

Rest.Rest. Schedule regular days off from vigorous exercise and rest when tired. Fatigue and painare good reasons to not exercise.

AAvvoid the "weekoid the "weekend warrior" syndrome.end warrior" syndrome. Try to get at least 30 minutes of moderate physicalactivity every day. If you are truly pressed for time, you can break it up into 10-minute chunks.



SprainsStrainsContusions (Bruises)TendinitisBursitis

sprains strains and other soft-tissue injuries

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